Are first rib fractures a marker for other life-threatening injuries in patients with major trauma? A cohort study of patients on the UK Trauma Audit and Research Network database
I. Sammy, H. Chatha, F. Lecky, O. Bouamra, M. Fragoso-Iñiguez, A. Sattout, Michael Hickey, J. Edwards
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引用次数: 25
Abstract
Background First rib fractures are considered indicators of increased morbidity and mortality in major trauma. However, this has not been definitively proven. With an increased use of CT and the potential increase in detection of first rib fractures, re-evaluation of these injuries as a marker for life-threatening injuries is warranted. Methods Patients sustaining rib fractures between January 2012 and December 2013 were investigated using data from the UK Trauma Audit and Research Network. The prevalence of life-threatening injuries was compared in patients with first rib fractures and those with other rib fractures. Multivariate logistic regression was performed to determine the association between first rib fractures, injury severity, polytrauma and mortality. Results There were 1683 patients with first rib fractures and 8369 with fractures of other ribs. Life-threatening intrathoracic and extrathoracic injuries were more likely in patients with first rib fractures. The presence of first rib fractures was a significant predictor of injury severity (Injury Severity Score >15) and polytrauma, independent of mechanism of injury, age and gender with an adjusted OR of 2.64 (95% CI 2.33 to 3.00) and 2.01 (95% CI 1.80 to 2.25), respectively. Risk-adjusted mortality was the same in patients with first rib fractures and those with other rib fractures (adjusted OR 0.97, 95% CI 0.79 to 1.19). Conclusion First rib fractures are a marker of life-threatening injuries in major trauma, though they do not independently increase mortality. Management of patients with first rib fractures should focus on identification and treatment of associated life-threatening injuries.
背景:第一肋骨骨折被认为是重大创伤中发病率和死亡率增加的指标。然而,这还没有得到明确的证实。随着CT使用的增加和第一肋骨骨折的潜在检测增加,重新评估这些损伤作为危及生命的损伤的标志是有必要的。方法采用英国创伤审计与研究网络的数据,对2012年1月至2013年12月的肋骨骨折患者进行调查。对第一肋骨骨折患者和其他肋骨骨折患者的危及生命的损伤发生率进行了比较。采用多变量logistic回归来确定第一肋骨骨折、损伤严重程度、多发伤和死亡率之间的关系。结果第一肋骨骨折1683例,其他肋骨骨折8369例。危及生命的胸内和胸外损伤更可能发生在第一肋骨骨折的患者中。第一肋骨骨折的存在是损伤严重程度(损伤严重程度评分bbb15)和多发伤的重要预测因子,与损伤机制、年龄和性别无关,调整后OR分别为2.64 (95% CI 2.33 ~ 3.00)和2.01 (95% CI 1.80 ~ 2.25)。第一肋骨骨折患者和其他肋骨骨折患者的风险调整死亡率相同(调整OR 0.97, 95% CI 0.79至1.19)。结论第一肋骨骨折是重大创伤中危及生命的损伤的标志,尽管它不会独立增加死亡率。第一肋骨骨折患者的管理应侧重于识别和治疗相关的危及生命的损伤。